As U.N. food trucks rumbled through damp streets in Gonaives on Saturday, dozens of children raised their arms and ran after them.
"Hungry! Hungry!" they yelled.
U.N. envoy Hedi Annabi, visiting a shelter where hundreds of people pushed and shoved for water and high-energy biscuits, said relief was trickling in, but that much more was needed.
More bad weather could impede aid deliver, recovery of bodies and - with the ground already saturated and rivers overflowing - kill even more people.
With Hurricane Ike approaching, the National Hurricane Center in Miami issued a tropical storm warning Saturday for parts of Haiti, including Gonaives. The storm's maximum sustained winds slipped a little Saturday morning, to near 110 mph (175 kph), but it was expected to regain force over the coming two days.
The U.N. World Food Program said Saturday that successive deadly storms have displaced hundreds of thousands of people and destroyed scores of homes and plantations.
"WFP has first-rate logistics, and this storm system is putting us to the test," said Myrta Kaulard, WFP Representative in Haiti.
The rusty container ship Trois Rivieres, chartered by the WFP, arrived belching white smoke at a remote private port outside the city on Friday. It was guarded by Argentine peacekeepers brandishing assault rifles.
Within hours, the U.N. began distributing high-energy biscuits and water to emergency shelters where at least 40,000 people were marooned and increasingly desperate. Operations were suspended at dusk, considering it too dangerous to work in the city after dark.
At an empty warehouse in the northern section of the city where floodwaters have receded, about 1,000 hungry and thirsty men and women, some cradling youngsters, pushed and shoved as civil protection authorities in orange T-shirts tried to get them in line. U.N. peacekeeping troops from Argentina stood by, assault rifles at the ready.
Anna Achelis, whose house was completely submerged, emerged from the melee holding one of her identical 3-year-old twin girls along with two bottles of water, five vitamin-enriched biscuits and a box of toiletries. She said she hoped the biscuits would stave off hunger for her five children and would try to make them last.
Some people who already had received food knocked cookies from the hands of other people, then scrambled on the floor to retrieve them.
At another shelter, U.N. peacekeepers had to leave the food in piles because shelter officials had not prepared to distribute it.
More than 10,000 people have left Gonaives on foot, swimming and wading through floodwaters and heading for the next town about 45 miles to the south, said Daniel Rouzier, Haiti chairman of Food for the Poor.
"The exodus out of Gonaives is massive," he said.
Marie Alta Jean-Baptiste, director of the Haitian civil protection department, said 163 deaths had been confirmed, including 119 in and around Gonaives.
Police director Godson Orleus, whose Artibonite region includes Gonaives, said officials fear fatalities could rise into the hundreds based on interviews with residents, but he disputed reports that hundreds more had died.
With the skies finally clear, aid also began to trickle in by air Friday. At least eight U.N. helicopters carrying personnel and food landed at the peacekeepers' base at the foot of a deforested mountain. A pair of U.S. Coast Guard helicopters brought in food donated by the U.S. Agency for International Development.
But the respite was expected to be brief. Ike was forecast to pass just north of Haiti on Sunday. Even if Haiti avoids a direct hit, Ike is almost certain to bring rain to the fertile Artibonite Valley, whose rivers funnel into Gonaives, Haiti's fourth-largest city, and the surrounding flood plain.
"It's such a moist environment, so rain is almost a no-brainer.
Now, how much rain is tough to say," meteorologist John Cangialosi said at the U.S. National Hurricane Center in Miami.
Max Cocsi, who directs Belgium's mission in Haiti of Doctors Without Borders, noted it would take little rain to compound the disaster because the soil is already saturated and rivers are overflowing from three tropical storms in less than three weeks.
The two earlier storms - Fay and Gustav - killed at least 96 other Haitians.
"We don't need a hurricane - a storm would be enough," he said.
Rescue convoys have been blocked for days by floodwaters, collapsed bridges and washed-out roads. A U.S. plane from Miami delivered enough relief supplies for 20,000 people to the capital Thursday, much of which was brought to Gonaives by a U.S. Coast Guard cutter and by air.
These shipments - including health kits, plastic sheeting and water jugs - will be followed by more aid as soon as officials figure out how to get it in, U.S. Embassy spokeswoman Mari Tolliver said.
The U.S. Southern Command diverted the amphibious USS Kearsarge from Colombia to Haiti to assist in the relief effort. The ship should arrive Sunday and has a medical unit that includes four operating rooms and 53 beds.
The tropical storms have compounded Haiti's misery. The Western Hemisphere's poorest country was already suffering from rising prices and government disorder following April food riots that unseated the prime minister.